CAJ | 학술논문

目的回顾分析手术治疗的早期胃癌病理资料,探讨早期胃癌行内镜黏膜下剥离术(ESD)的可行性和手术指征.方法收集上海华山医院2007至2011年间经手术治疗的胃癌病理资料,分析符合日本胃癌协会ESD治疗标准的早期胃癌的情况.比较不同浸润深度、分化类型的早期胃癌局部转移的情况.结果 2007至2011年间共手术治疗胃癌1159例,其中早期胃癌210例(18.1％),有151例符合ESD扩大指征,126例符合ESD标准适应证,分别占胃癌手术量的13.0％、10.9％,占早期胃癌的71.9％、60.0％.在210例早期胃癌中,黏膜内癌(m癌)、黏膜肌层癌(mm癌)、黏膜下层第1层癌(sm1癌)、黏膜下层第2层癌(sm2癌)的局部转移率分别为6.8％(5/74)、15.0％ (6/40)、23.3％ (10/43)、39.6％ (21/53),组间比较差异有统计学意义(P＜0.01).分化型早癌与非分化型早癌的局部转移率分别为14.0％(24/172)、47.4％ (18/38) (P ＜0.01).结论行胃癌根治术的早期胃癌患者较大部分可以选择ESD治疗.早期胃癌的区域转移与浸润深度和分化程度明显相关,故有必要严格掌握ESD的适用指征.
목적 회고분석수술치료적조기위암병리자료,탐토조기위암행내경점막하박리술(ESD)적가행성화수술지정.방법 수집상해화산의원2007지2011년간경수술치료적위암병리자료,분석부합일본위암협회ESD치료표준적조기위암적정황.비교불동침윤심도、분화류형적조기위암국부전이적정황.결과 2007지2011년간공수술치료위암1159례,기중조기위암210례(18.1％),유151례부합ESD확대지정,126례부합ESD표준괄응증,분별점위암수술량적13.0％、10.9％,점조기위암적71.9％、60.0％.재210례조기위암중,점막내암(m암)、점막기층암(mm암)、점막하층제1층암(sm1암)、점막하층제2층암(sm2암)적국부전이솔분별위6.8％(5/74)、15.0％ (6/40)、23.3％ (10/43)、39.6％ (21/53),조간비교차이유통계학의의(P＜0.01).분화형조암여비분화형조암적국부전이솔분별위14.0％(24/172)、47.4％ (18/38) (P ＜0.01).결론 행위암근치술적조기위암환자교대부분가이선택ESD치료.조기위암적구역전이여침윤심도화분화정도명현상관,고유필요엄격장악ESD적괄용지정.
Objective To evaluate the feasibility and indications of endoscopic submucosal dissection (ESD) by analyzing the early gastric cancer cases.Methods All the pathological materials of radical gastric resections in Huashan hospital from 2007 to 2011 were retrieved and the EGC cases were selected.All the cases in EGC group which met the extended ESD criteria were reviewed.Extended ESD criteria were cited from "Treatment guidelines for gastric cancer in Japan" edited by JGCA in 2001.The risk factors relevant with regional metastasis,such as invasive depth and differentiation degrees,were also analysed.Results In the recent five years,there were 1159 cases of gastric cancer undergoing radical gastrectomy in Huashan hospital including 210 EGC.According to the extended criteria of JGCA,151 cases could be candidates for ESD while 126 cases could be candidates for ESD according to the typical criteria for ESD.The local metastases of lymphatic or vascular involvement for mucosa cancer,muscularis mucosae cancer,sm1 and sm2 cancer were 6.75％,15.00％,23.25％,and 39.62％ respectively (P ＜0.05).Twenty-five cases had local metastases that met the extended criteria for ESD.Within the 210 EGC cases,the local metastases of differentiated type and undifferentiated type were 13.95％ and 47.37％ respectively (P ＜ 0.05).Conclusion Most EGC cases undergoing radical gastrectomy can be cured by ESD.Its metastases are highly correlated with invasion depth and differentiation,so indications of ESD should be assessed.